Provider Demographics
NPI:1063723153
Name:LOGAN, SARAH E B (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:E B
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 HOLIDAY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-2040
Mailing Address - Country:US
Mailing Address - Phone:802-281-6364
Mailing Address - Fax:802-281-6365
Practice Address - Street 1:212 HOLIDAY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-2040
Practice Address - Country:US
Practice Address - Phone:802-281-6364
Practice Address - Fax:802-281-6365
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH390200000X
CA390200000X
VT042.0012890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program